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Björk-Shiley Convexoconcave Valves: Susceptibility Artifacts at Brain MR Imaging and Mechanical Valve Fractures¹

¹ From the Julius Center for Health Sciences and Primary Care (M.J.v.G., Y.v.d.G.) and Department of Radiology (C.J.G.B., T.D.W., L.M.P.R., W.P.T.M.M.), University Medical Center Utrecht, Heidelberglaan 100, PO Box 85500, Room D01.335, 3508 GA Utrecht, the Netherlands; and Department of Cardiothoracic Surgery, Academic Medical Center, Amsterdam, the Netherlands (B.A.J.M.d.M.). From the 2000 RSNA scientific assembly. Received November 26, 2002; revision requested February 20, 2003; final revision received July 3; accepted July 28. Address correspondence to Y.v.d.G. (e-mail: Y.vanderGraaf@jc.azu.nl).

PURPOSE: To assess the relationship between heart valve history and susceptibility artifacts at magnetic resonance (MR) imaging of the brain in patients with Björk-Shiley convexoconcave (BSCC) valves.

MATERIALS AND METHODS: MR images of the brain were obtained in 58 patients with prosthetic heart valves: 20 patients had BSCC valve replacements, and 38 had other types of heart valves. Two experienced neuroradiologists determined the presence or absence of susceptibility artifacts in a consensus reading. Artifacts were defined as characteristic black spots that were visible on T2*-weighted gradient-echo MR images. The statuses of the 20 explanted BSCC valves—specifically, whether they were intact or had an outlet strut fracture (OSF) or a single-leg fracture (SLF)—had been determined earlier. Number of artifacts seen at brain MR imaging was correlated with explanted valve status, and differences were analyzed with nonparametric statistical tests.

RESULTS: Significantly more patients with BSCC valves (17 [85%] of 20 patients) than patients with other types of prosthetic valves (18 [47%] of 38 patients) had susceptibility artifacts at MR imaging (P = .005). BSCC valve OSFs were associated with a significantly higher number of artifacts than were intact BSCC valves (P = .01). No significant relationship between SLF and number of artifacts was observed.

CONCLUSION: Susceptibility artifacts at brain MR imaging are not restricted to patients with BSCC valves. These artifacts can be seen on images obtained in patients with various other types of fractured and intact prosthetic heart valves.

© RSNA, 2004

Index terms: Brain, MR, 13.121411, 13.121412 • Heart, prostheses, 51.4534 • Heart, valves, 51.4534 • Magnetic resonance (MR), artifact, 13.121411, 13.121412

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